Abstract
Recurrent vulvovaginal candidiasis (RVVC) is a relapsing vaginal fungal infection caused by Candida species. The prevalence varies among age populations and can be as high as 9%. Treatment options are limited, and in 57% of the cases, relapses occur within six months after fluconazole maintenance therapy, which is the current standard of care. The pathogenesis of RVVC is multifactorial, and recent studies have demonstrated that the vaginal microenvironment and activity of the immune system have a strong influence on the disease. Medical-grade honey (MGH) has protective, antimicrobial, and immunomodulatory activity and forms a putative alternative treatment. Clinical trials have demonstrated that honey can benefit the treatment of bacterial and Candida-mediated vaginal infections. We postulate that MGH will actively fight ongoing infections; eradicate biofilms; and modulate the vaginal microenvironment by its anti-inflammatory, antioxidative, and immunomodulatory properties, and subsequently may decrease the number of relapses when compared to fluconazole. The MGH formulation L-Mesitran Soft has stronger antimicrobial activity against various Candida species than its raw honey. In advance of a planned randomized controlled clinical trial, we present the setup of a study comparing L-Mesitran Soft with fluconazole and its practical considerations.
Highlights
Vulvovaginal candidiasis (VVC) is a vaginal fungal infection confirmed to be caused by Candida species, in most cases Candida albicans [1]
Epidemiologic studies confirm that mostly all women diagnosed with fluconazole-resistant Candida albicans were previously exposed to fluconazole [48]
Besides the efficacy of honey against Candida albicans, several studies have demonstrated the susceptibility of non-albicans species (NAC) species such as Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida kefyr, and Candida dubliniensis to honey, which could fulfill the growing demand for new antifungal agents [62,75,81]
Summary
Vulvovaginal candidiasis (VVC) is a vaginal fungal infection confirmed to be caused by Candida species, in most cases Candida albicans [1]. Women report loss of confidence and self-esteem, inability to carry on with their normal physical activities, and difficulties with their sexual life and intimate relationships [2]. It has a profound effect on the quality of life of affected women with additional systemic symptoms including depression and anxiety [1]. It is estimated that the population of women with recurrent vulvovaginal candidiasis will increase to almost 158 million in 2030 [2]. It is important to know more about the etiology of RVVC, the different treatment options, and their efficacy to understand how novel therapies could improve the clinical outcome and quality of life
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